How to Safely Take Antidepressants

Depression | How to Safely Take Antidepressants

How will my doctor choose an antidepressant for me?

Your doctor will probably think about the following 10 points when choosing an antidepressant medicine for you:

1. If you were depressed before and a certain antidepressant worked well, that antidepressant might be the right choice of medicine for you again.
2. If any of your brothers or sisters, parents, uncles or aunts had depression and a certain antidepressant worked well for them, that medicine might work for you too.
3. The choice of an antidepressant depends on your health. If a certain antidepressant would have a bad effect on a health problem you have, that medicine wouldn't be the right choice for you.
4. Antidepressants can have side effects. The right medicine for you may be the one that gives you the fewest side effects.
5. The choice of an antidepressant depends on how often you have to take it. The less often you have to take the medicine, the easier it is for you to take all the doses you need to treat your depression.
6. Some antidepressants cost more than others. Your doctor will choose an antidepressant that works for you and that you can afford.
7. Your doctor will want to choose a medicine he or she has experience prescribing.
8. Your doctor will choose an antidepressant that will help you with symptoms like sleeplessness, anxiety and lack of energy.
9. If you're taking other medicines, your doctor will consider how an antidepressant will work with these other medicines.
10. Some antidepressants don't work well with certain foods. If your doctor gives you one of these antidepressants, he or she will let you know which foods you should stop eating.

Are antidepressants tranquilizers or "uppers"? Can I get addicted to them?

No. These drugs aren't tranquilizers. They don't give you a "high." They aren't addictive.

Do antidepressants cause side effects?

Yes. All antidepressants have some side effects. However, not all people taking antidepressants get these side effects. Most of the side effects happen in the early weeks of therapy and lessen over time.

What are some of the common side effects of antidepressants?

Different antidepressants can cause different side effects. Possible side effects may include the following:

• Anxiety
• Bladder problems
• Blurred vision
• Constipation
• Diarrhea
• Dizziness when standing up
• Dry mouth
• Excessive tiredness
• Feeling of weakness
• Hand tremors
• Increased heart rate
• Increased sleepiness
• Insomnia
• Muscle twitching
• Nausea
• Sexual dysfunction (inability to ejaculate or to have an orgasm)
• Tremor
• Vomiting
• Weight gain

What if the side effects don't go away?

Talk to your doctor. He or she may change your dosage, or you might try another medicine to get rid of the side effects.

How will I know if my antidepressant is working?

You will be able to sleep better. You'll be better able to meet your day-to-day obligations and take care of yourself. You will have more energy. Your weight problems will get better, and your appetite will be closer to normal. You will have an increased desire to engage in life. You and your family and friends will notice these changes. Be patient, though. It may take some time to get back to the way you felt before the depression.

How long will I take the antidepressant?

Antidepressants are usually taken every day. It can take up to a month to see the full results of taking an antidepressant. You may need to try different kinds or amounts (dosages) to find the antidepressant that works best for you. Your doctor will let you know how long to take your antidepressant. If this is the first time you have been treated for depression, you will probably continue to take this medicine for about 6 months after you begin to feel better. If this is the second time you've been depressed, you might keep taking the medicine for at least a year. Depression that comes back a third time may require you to continue taking an antidepressant for a long time.
You can get unwanted side effects if you stop taking your antidepressant suddenly. If you want to stop taking your medicine, talk to your doctor first. Your doctor can help you avoid any side effects from stopping the medicine too quickly.

Can I drink alcohol when I'm taking an antidepressant?

You should be careful about drinking alcohol until you know how the medicine affects you. The affects of alcohol can combine with the affects of the antidepressant and cause problems. Regular heavy drinking can make it harder to treat the depression and certain kinds of medicine can lead to seizures for heavy drinkers. Talk to your doctor about drinking while taking an antidepressant.

Will antidepressants affect my other medicines?

Antidepressants can have an effect on many other medicines. If you're going to take an antidepressant, tell your doctor about all the other medicines you take, including over-the-counter medicines and herbal health products (such as St. John's wort). Ask your doctor and pharmacist if any of your regular medicines can cause problems when combined with an antidepressant.

What is antidepressant discontinuation syndrome?

Antidepressant discontinuation syndrome can occur if you suddenly stop taking your antidepressant medicine. Antidepressant discontinuation syndrome is not dangerous or life threatening and usually goes away within 1 week.
The symptoms include:

• Anxiety
• Feelings of sadness
• Irritability
• Fatigue
• Headaches
• Nausea and vomiting
• Dizziness

Which antidepressants can cause this problem?

You are more likely to have a problem if you stop taking certain antidepressants, such as paroxetine and sertraline, but you can get symptoms from stopping any antidepressant medicine.

What can I do if I have antidepressant discontinuation syndrome?

If you accidentally missed a dose of your antidepressant medicine, start taking it again as soon as possible. If you are out of medicine, call your doctor so he or she can refill your prescription.
If you decided to stop taking your antidepressant medicine on your own, talk to your doctor about why you stopped. For example, was the medicine causing an unpleasant side effect? Your doctor can help by altering your dosage or suggesting another type of antidepressant.
If your doctor recommended that you take a lower dosage of your medicine and you are experiencing symptoms of antidepressant discontinuation syndrome, talk with your doctor. You may need to take a higher dosage for a period of time before weaning your body from the medicine completely.

How do I keep this from happening again?

Take your medicine exactly as your doctor tells you. If you want to stop taking your medicine, talk to your doctor first. Just because you are unable to stop taking your medicine all at once does not mean that you are addicted. Your body often needs time to adjust to lower levels of the medicine. This is why your doctor may recommend tapering off of antidepressant medicine rather than abruptly stopping it.

Are antidepressants safe for children and teens?

In some cases, the use of antidepressants has been linked to an increase in suicidal thoughts and suicidal behavior in children, teens and young adults. The Food and Drug Administration (FDA) now requires antidepressants to carry a warning about the risk of suicide in children, teens, and young adults 24 years of age or younger. However, this doesn't mean that people in this age group should not take antidepressants. It does mean that they should be carefully monitored by their doctors and loved ones while they are on an antidepressant.
Many doctors will want to see a child or teen sometime in the first few weeks after starting an antidepressant to assess any risk for suicide. If you are worried that your child may be suicidal, call your doctor right away or take your child to the nearest emergency room.

Are antidepressants safe for any woman who has depression?

If you're planning to get pregnant, talk to your doctor about your medicines before you try to get pregnant. If you accidentally get pregnant while you're taking an antidepressant, tell your doctor right away. Your doctor will know if your particular antidepressant is safe to take.
All medicine you take passes into your breast milk. If you are planning to breastfeed or you currently breastfeed, talk to your doctor about your medicine.
In most cases, it's okay to take birth control pills or hormone replacement therapy (also called HRT) at the same time as depression medicines. Taking hormones may even help some depressed women feel better. However, if your birth control pills seem to be causing symptoms of depression, discuss this with your doctor. He or she may suggest you use another method to prevent pregnancy for several months in order to find out if your birth control pills are causing depression.

This content has been supported by Forest Laboratories Inc.

Written by familydoctor.org editorial staff

Reviewed/Updated: 09/12
Created: 06/96

Xeplion (paliperidone)

Main use	Active ingredient	Manufacturer
Schizophrenia	Paliperidone palmitate	Janssen-Cilag

How does it work?

Xeplion injections contain the active ingredient paliperidone, which is a type of medicine called an atypical antipsychotic.

Paliperidone works in the brain, where it affects various neurotransmitters, in particular dopamine and serotonin (5HT). Neurotransmitters are chemicals that are stored in nerve cells and are involved in transmitting messages between the nerve cells.

Dopamine and serotonin are neurotransmitters known to be involved in regulating mood and behaviour, amongst other things. Psychotic illness is considered to be caused by disturbances in the activity of neurotransmitters (mainly dopamine) in the brain. Schizophrenia is known to be associated with an overactivity of dopamine in the brain, and this may be associated with the delusions and hallucinations that are a feature of this disease.

Paliperidone works by blocking the receptors in the brain that dopamine acts on. This prevents the excessive activity of dopamine and helps to control schizophrenia.

People with schizophrenia may experience 'positive symptoms' (such as hallucinations, disturbances of thought, hostility) and/or 'negative symptoms' (such as lack of emotion and social withdrawal). Paliperidone is effective in relieving both positive and negative symptoms of schizophrenia, whereas older antipsychotics are usually less effective against the negative symptoms.

Paliperidone also relieves 'affective symptoms' that are associated with schizophrenia, such as depression, guilt feelings or anxiety.

Xeplion injection is a type of injection called a depot injection. It is administered into the muscle of the upper arm or buttock, where it forms a reservoir of medicine that is slowly released into the bloodstream. The injection is given once every four weeks.

What is it used for?

• Schizophrenia (in people who have previously responded to paliperidone or risperidone treatment taken by mouth).

How is this treatment given?

• This medicine is for injection into a muscle only. It must not be administered under the skin or into a vein. You will be given the injection by a medical professional who has been appropriately trained in the technique.
• Xeplion injection is administered into the muscle of either the buttock or the upper arm, where it forms a reservoir of medicine that is slowly released into the bloodstream.
• The first two doses of the injection are given into the upper arm, one week apart, to allow for the concentration of the medicine to build up rapidly in the body. After that, Xeplion is given once a month into either the upper arm or buttock. The injection site should be alternated between the left and right sides of the body. It is a good idea to make a note of the date when your injection is administrated and when your next injection is due. (Your monthly injection can be given a week early or a week late if necessary.)
• Unless your doctor tells you otherwise, you should not suddenly stop treatment with this medicine, even if you feel better and think you don't need it any more. This is because the medicine controls the symptoms of the illness but doesn't actually cure it. This means that if you suddenly stop having the injections your symptoms could come back. When treatment with this medicine is stopped, it should be done gradually, following the instructions given by your doctor.

Warning!

• This medicine may cause drowsiness or dizziness. If affected do not drive or operate machinery. You should avoid drinking alcohol because it is likely to make any drowsiness or dizziness worse.
• This medicine can occasionally cause your blood pressure to drop when you move from a lying down or sitting position to sitting or standing, especially when you first start treatment with the medicine. This may make you feel dizzy or unsteady. To avoid this try getting up slowly. If you do feel dizzy, sit or lie down until the symptoms pass.
• This medicine can cause some people to put on weight and your doctor will want to weigh you regularly. Talk to your doctor about this before you start treatment so that you can discuss strategies, such as diet and exercise, for minimising any weight gain.
• Antipsychotic medicines can sometimes affect the ability of the body to control its core body temperature. This is more likely to be a problem in elderly people and can result in heat stroke in hot temperatures and hypothermia in cold temperatures. It is important to avoid situations that can result in you overheating or getting dehydrated. Ask your doctor or pharmacist for more advice.
• This medicine may rarely cause a decrease in the normal amounts of blood cells in the blood. For this reason you should consult your doctor immediately if you experience any of the following symptoms: unexplained bruising or bleeding, purple spots, sore throat, mouth ulcers, high temperature (fever), feeling tired or general illness. Your doctor may want to take a blood test to check your blood cells.
• Antipsychotic medicines are associated with an increased risk of getting a blood clot in a vein (deep vein thrombosis) or in the lungs (pulmonary embolism). For this reason, you should consult a doctor immediately if you get any of the following symptoms, which could suggest you have a blood clot: stabbing pains and/or unusual redness or swelling in one leg, pain on breathing or coughing, coughing up blood or sudden breathlessness.
• Consult your doctor immediately if you experience any abnormal movements, particularly of the face, lips, jaw and tongue, while you are on this medicine. These symptoms may be indicative of a rare side effect known as tardive dyskinesia, and your doctor may ask you to stop treatment with this medicine, or decrease your dose.
• Consult your doctor immediately if you experience the following symptoms while having Xeplion injections: high fever, sweating, muscle stiffness, faster breathing and drowsiness or sleepiness. These symptoms may be due to a rare side effect known as the neuroleptic malignant syndrome, and your treatment may need to be stopped.

Use with caution in

• Elderly people.
• Severely decreased liver function.
• Decreased kidney function.
• Diabetes (if you have diabetes your blood sugar levels should be monitored closely while you are having treatment with this medicine, because it may increase your blood sugar).
• People with disease involving the heart and blood vessels (cardiovascular disease) for example heart failure, angina, previous heart attack or an irregular heartbeat (arrhythmia).
• People with a personal or family history of an abnormal heart rhythm seen as a 'prolonged QT interval' on a heart monitoring trace or ECG.
• People with low blood pressure (hypotension).
• People who are dehydrated.
• People with a history or risk of stroke or small temporary strokes (transient ischaemic attacks).
• Elderly people with dementia and a risk of stroke (other similar antipsychotic medicines are associated with an increased risk of stroke and death in this group of people).
• People with a personal or family history of blood clots (venous thromboembolism), for example in a vein of the leg (deep vein thrombosis) or in the lungs (pulmonary embolism).
• People with other risk factors for getting a blood clot, for example smoking, being overweight, taking the contraceptive pill, being over 40, recent major surgery or being immobile for prolonged periods.
• People with a history of seizures, eg epilepsy.
• People with conditions that increase the risk of epilepsy or convulsions, eg brain damage or withdrawal from alcohol.
• Parkinson's disease.
• People with a history of a drop in the numbers of white blood cells in the blood, particularly if this was caused by a medicine.
• People with a tumour of the pituitary gland in the brain that produces the hormone prolactin (prolactinoma).
• People with tumours whose growth may be stimulated by the hormone prolactin, eg breast cancer.

Not to be used in

• People who are allergic to risperidone.
• Breastfeeding.
• This medicine is not recommended for people with moderate to severely decreased kidney function.
• This medicine is not recommended for children less than 18 years of age, as its safety and efficacy have not been established in this age group.
• Xeplion injection does not work quickly enough to manage people who are acutely agitated or in a severely psychotic state and who need a treatment that immediately controls their symptoms.

This medicine should not be used if you are allergic to any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy. If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.

Pregnancy and breastfeeding

Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.

• The safety of this medicine for use during pregnancy has not been established. It should not be used during pregnancy unless considered essential by your doctor, and only if the potential benefits to the mother outweigh any possible risks to the unborn child. Antipsychotics used during the third trimester could cause side effects or withdrawal symptoms in the baby after birth and the baby may need extra monitoring because of this. Seek further medical advice from your doctor.
• If you do get pregnant while having treatment with this medicine it is important to consult your doctor straight away for advice. You should not suddenly stop treatment with this medicine unless your doctor tells you to, as this could cause your symptoms to come back.
• This medicine passes into breast milk and could be harmful to a nursing infant. It should not be used during breastfeeding. Mothers who need treatment with this medicine should not breastfeed. Seek further medical advice from your doctor.

Label warnings

• This medication may cause drowsiness. If affected do not drive or operate machinery. Avoid alcoholic drink.

Side effects

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.

Very common (affect more than 1 in 10 people)

• Difficulty sleeping (insomnia).
• Headache.

Common (affect between 1 in 10 and 1 in 100 people)

• Dizziness.
• Sleepiness (somnolence).
• Depression.
• Anxiety, restlessness and agitation (akathisia).
• Abnormal movements of the hands, legs, face, neck and tongue, eg tremor, twitching, rigidity (extrapyramidal effects).
• Faster or slower than normal heartbeat.
• Cough.
• Blocked nose.
• Disturbances of the gut such as nausea, vomiting, abdominal pain or discomfort, indigestion, diarrhoea or constipation.
• Fatigue, weakness or loss of strength (asthenia).
• Reaction at site of injection.
• Infection of the upper respiratory tract.
• High blood pressure.
• Back pain.
• Increased blood glucose levels. Tell your doctor if you notice you feel unusually hungry or thirsty, or need to pass urine more often than usual. People with diabetes should monitor their blood sugar closely.
• Increased weight. Your doctor will want to weigh you regularly to make sure you are not gaining too much weight.
• Elevated levels of fats called triglycerides in the blood.
• Rash.
• High blood prolactin (milk producing hormone) level (hyperprolactinaemia). This may uncommonly lead to symptoms such as breast enlargement, production of milk and menstrual disturbances.

Uncommon (affect between 1 in 100 and 1 in 1000 people)

• Sexual problems such as reduced sex drive and erectile dysfunction.
• Changes in appetite.
• Increased level of cholesterol in the blood.
• Confusion.
• Nightmares.
• Drop in blood pressure causing dizziness that occurs when moving from a lying down or sitting position to sitting or standing - see warning section above.
• Sensation of spinning.
• Sensation of ringing, or other noise in the ears (tinnitus).
• Dry mouth.
• Blurred vision, dry eyes, conjunctivitis.
• Muscle spasms.
• Stiff or aching joints.
• Skin reactions such as nettle rash (hives), eczema, dry skin, acne and itching.
• Abnormal heart rhythm seen as a 'prolonged QT interval' on a heart monitoring trace or ECG.
• Irregular heart beat called atrial fibrillation.
• Awareness of heartbeat (palpitations).
• Shortness of breath.
• Tardive dyskinesia (see warning section above).
• Tingling, pins and needles or numb sensations.
• Convulsions.
• Problems with speech.
• Decreased numbers of blood cells in the blood (see warning section above).
• Infections.
• Abnormally frequent urination, painful urination or urinary incontinence.

Rare (affect between 1 in 1000 and 1 in 10,000 people)

• Neuroleptic malignant syndrome (see warning section above).
• Problem with eye movement such as rolling of the eyes into the back of the head.
• Watery or red eyes.
• Bruising, inflammation, cysts or abscess at site of injection.
• Blood clot in the leg or the lungs (thromboembolism) – see warning section above.
• Prolonged erection in men. (If you get an erection that lasts longer than four hours (priapism) having these injections, you should consult a doctor immediately. Treatment of this condition should not be delayed more than six hours, as this can cause damage to the erectile tissue in the penis and irreversible erectile dysfunction.)
• Problems with body temperature control – see warning section above.

The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.

For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.

How can this medicine affect other medicines?

It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while having treatment with this one, to make sure that the combination is safe.

There may be an increased risk of drowsiness and sedation if paliperidone is used with any of the following (which can also cause drowsiness):

• alcohol
• tricyclic antidepressants, eg amitriptyline
• strong opioid painkillers, eg morphine, codeine, dihydrocodeine
• benzodiazepines, eg diazepam, temazepam
• sedating antihistamines, eg chlorphenamine, hydroxyzine
• sleeping tablets, eg zopiclone.

Paliperidone may enhance the blood pressure-lowering effects of medicines that lower blood pressure, including medicines used to treat high blood pressure (antihypertensives) and medicines that lower blood pressure as a side effect, eg benzodiazepines. If you are taking medicines that lower blood pressure you should tell your doctor if you feel dizzy or faint after starting treatment with this medicine, as your doses may need adjusting.

There may be an increased risk of an abnormal heart rhythm, seen as a ‘prolonged QT interval’ on an ECG, if other medicines that can have this effect are used by people treated with paliperidone. These medicines include the following:

• antiarrhythmics (medicines to treat abnormal heartbeats), eg amiodarone, procainamide, disopyramide, sotalol
• the antihistamines astemizole, mizolastine or terfenadine
• arsenic trioxide
• atomoxetine
• certain antidepressants, eg amitriptyline, imipramine, maprotiline
• certain antimalarials, eg halofantrine, chloroquine, quinine, mefloquine, Riamet
• certain other antipsychotics, eg thioridazine, haloperidol, sertindole, pimozide
• cisapride
• dronedarone
• droperidol
• intravenous erythromycin or pentamidine
• methadone
• moxifloxacin
• saquinavir.

There may also be an increased risk of a prolonged QT interval if medicines that can alter the levels of salts such as potassium or magnesium in the blood, eg diuretics such as furosemide, are taken in combination with paliperidone.

Paliperidone may oppose the effect of medicines for Parkinson's disease that work by stimulating dopamine receptors in the brain, for example levodopa, ropinirole, pergolide, bromocriptine.

Paliperidone may oppose the effect of anticonvulsant medicines used to treat epilepsy.

Paliperidone may increase blood sugar levels and disturb the control of diabetes. People with diabetes may need an adjustment in the dose of their antidiabetic medication.

Paliperidone may oppose the effect of histamine (used to treat leukaemia) and is not recommended for people having this treatment.

The following medicines may speed up the breakdown of paliperidone in the body and so could make it less effective. If you take any of these medicines your doctor may need to increase your dose of paliperidone:

• carbamazepine
• rifampicin
• the herbal remedy St John's wort (Hypericum perforatum).

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Paliperidone

IMPORTANT WARNING:

Studies have shown that older adults with dementia (a brain disorder that affects the ability to remember, think clearly, communicate, and perform daily activities and may cause changes in mood and personality) who take antipsychotics (medications for mental illness) such as paliperidone have an increased risk of death during treatment. Older adults with dementia may also have a greater chance of having a stroke or ministroke during treatment.

Paliperidone is not approved by the Food and Drug Administration (FDA) for the treatment of behavior problems in older adults with dementia. Talk to the doctor who prescribed this medication, if you, a family member, or someone you care for has dementia and is taking paliperidone. For more information, visit the FDA website: http://www.fda.gov/Drugs

Why is this medication prescribed?

Paliperidone is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions). Paliperidone is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.

How should this medicine be used?

Paliperidone comes as an extended-release (long-acting) tablet to take by mouth. It is usually taken once a day in the morning with or without food. Take paliperidone at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take paliperidone exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the tablets whole with plenty of water or other liquid. Do not split, chew, or crush the tablets. Tell your doctor if you cannot swallow tablets. Your doctor will probably prescribe another medication to treat your condition.

Talk to your doctor about how you are feeling during your treatment. If your symptoms are still bothersome, your doctor may gradually increase your dose, not more often than once every 5 days.

Paliperidone controls the symptoms of schizophrenia but does not cure the condition. Continue to take paliperidone even if you feel well. Do not stop taking paliperidone without talking to your doctor.

Other uses for this medicine

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This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

What special precautions should I follow?

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Before taking paliperidone,

• tell your doctor and pharmacist if you are allergic to paliperidone, risperidone (Risperdal), or any other medications.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: antidepressants; certain antibiotics such as erythromycin (E.E.S., E-Mycin, Erythrocin), gatifloxacin (Tequin) (not available in the United States), moxifloxacin (Avelox), and sparfloxacin (Zagam); certain antipsychotics such as chlopromazine (Sonazine, Thorazine), pimozide (Orap), risperidone (Risperdal) and thioridazine; cisapride (Propulsid); levodopa (in Sinemet, in Stalevo); medications for anxiety, high blood pressure, or seizures; medications for irregular heartbeat such as amiodarone (Cordarone), disopyramide (Norpace), dofetilide (Tikosyn); procainamide (Procanbid, Pronestyl), quinidine (Quinidex), and sotalol (Betapace, Betapace AF); sedatives; sleeping pills; and tranquilizers. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had a prolonged QT interval (a rare heart problem that may cause fainting or irregular heartbeat); slow or irregular heartbeat; a heart attack; low levels of potassium or magnesium in your blood; seizures; a stroke; a head injury; a brain tumor; Parkinson's disease (a disorder of the nervous system that causes difficulties with movement, muscle control, and balance); diabetes; breast cancer; surgery involving the intestines; any condition that causes blockage or narrowing of the esophagus (tube that connects the mouth and stomach), stomach, or intestines such as cystic fibrosis (an inborn disease that causes problems with breathing, digestion, and reproduction), and inflammatory bowel disease (IBD; a group of conditions that cause swelling of the lining of the intestines); and kidney, heart, or liver disease. Also tell your doctor if you drink or have ever drunk large amounts of alcohol and if you use or have ever used street drugs or have overused prescription medications. Tell your doctor if you have ever had to stop taking a medication for mental illness because of severe side effects.
• tell your doctor if you are pregnant, especially if you are in the last few months of your pregnancy, or if you plan to become pregnant or are breast-feeding. If you become pregnant while taking paliperidone, call your doctor. Paliperidone may cause problems in newborns following delivery if it is taken during the last months of pregnancy.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking paliperidone.
• you should know that paliperidone may make you drowsy and may cause difficulty with thinking and movement. Do not drive a car or operate machinery until you know how this medication affects you.
• you should know that alcohol may add to the drowsiness caused by paliperidone. Do not drink alcoholic beverages while you are taking this medication.
• you should know that you may experience hyperglycemia (increases in your blood sugar) while you are taking this medication, even if you do not already have diabetes. If you have schizophrenia, you may be more likely to develop diabetes than people who do not have schizophrenia, and taking paliperidone or similar medications may increase this risk. Tell your doctor immediately if you have any of the following symptoms while you are taking paliperidone: extreme thirst, frequent urination, extreme hunger, blurred vision, or weakness. It is very important to call your doctor as soon as you have any of these symptoms, because high blood sugar can cause more serious symptoms, such as dry mouth, nausea and vomiting, shortness of breath, breath that smells fruity, or decreased consciousness, and may become life-threatening if it is not treated at an early stage.
• you should know that paliperidone may make it harder for your body to cool down when it gets very hot. Tell your doctor if you plan to exercise or be exposed to extreme heat.
• you should know that paliperidone may cause dizziness, lightheadedness, and fainting when you get up too quickly from a lying position. This is more common when you first start taking paliperidone or when your dose is increased. To avoid this problem, get out of bed slowly, resting your feet on the floor for a few minutes before standing up.

What special dietary instructions should I follow?

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Unless your doctor tells you otherwise, continue your normal diet.

What should I do if I forget a dose?

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Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

What side effects can this medication cause?

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Paliperidone may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• dizziness
• extreme tiredness
• weakness
• headache
• dry mouth
• increased saliva
• weight gain
• stomach pain

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately:

• fever
• muscle pain or stiffness
• confusion
• fast, pounding, or irregular heartbeat
• sweating
• unusual movements of your face or body that you cannot control
• slow or stiff movements
• restlessness
• painful erection of the penis that lasts for hours

Paliperidone may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

What should I know about storage and disposal of this medication?

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Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

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In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

• unusual movements of your face or body that you cannot control
• slow or stiff movements
• restlessness
• unsteadiness
• drowsiness
• fast heartbeat

What other information should I know?

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Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

You may notice something that looks like a tablet in your stool. This is just the empty tablet shell and does not mean that you did not get your complete dose of medication.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.